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JOB TITLE: Provider Support Representative/Pharmacy Technician
DEPARTMENT: Business Services
REPORTS TO: Director of Call Center and Operations
FLSA STATUS: Non-Exempt

 

JOB SUMMARY:

The level I PSR is responsible for all functions related to pharmacy provider services. A level I PSR interacts with clients, pharmacies, and local health jurisdiction site coordinators and workers, handling, resolving and taking ownership of internal and external pharmacy provider related problems.

RESPONSIBILITIES:

• Perform all regular functions relating to pharmacy provider services. These include:
  • Use PMDCtm Inhouse and Secure Web systems, policy and procedures as they relate to pharmacy provider services.
  • Use telephone protocol and communication methodology.
  • Perform prior authorization (PA) and claims processing based on program guidelines.
  • Perform Coverage gap processing.
  • Work with Clinical on validation of Drugs and formulary usage.
  • Use the HealthTrans online system to validate and follow-up on claims adjustments, suspensions and Prior Authorizations (PAs).
  • Support the Enrollment Department as needed, specifically in the areas of:
    • Member enrollment processes and basic CSR functions.
    • Enrollment phone coverage during peak times.
  • Process and act as liaison between pharmacies, clients and Sponsors for pharmacy related exceptions.
  • Serve as a liaison between program members and pharmacy providers.
• Serve as a liaison between program members and pharmacy providers.
• Use professional knowledge in PA processing, utilizing pharmacy technician skills in dosage calculations, client compliance, and knowledge of medications (trade, generic).
• Professionally handling incoming and return calls and maintaining an average call monitoring score as defined by the Operations Director.
• Provide optimum customer service.

REQUIREMENTS:

• Serve as primary point of contact with regard to providing information for and responding to program audits, where appropriate.
• Develop professionalism and mentor Leads and staff members.
• Be available to affect the entirety of the team's operations.
• Perform other miscellaneous duties as assigned.
• Continued education in the areas of project management, Call Center Operations, written and verbal communication skills, and computer skills.

OTHER SKILLS:

• Good written and verbal communication skills.
• Demonstrated positive interpersonal skills.
• Demonstrate sensitivity and professionalism; maintain a high level of confidentiality.
• Ability to work well independently and as a team member.
• Excellent listening skills including the ability to maintain composure during stressful situations with the ability to resolve issues for customers.
• Ability to comprehend and follow verbal and written instructions.
• Ability to exchange information with co-workers and work as part of a team.
• 10-key by touch.
• Bilingual in Spanish a plus.

EDUCATION:

• High School Diploma. Licensed Pharmacy Technician with valid Pharmacy Technician License.

EXPERIENCE:

• 10-key by touch.
• Basic knowledge of Windows Operating System 2000 or higher and basic use of MS Excel and Word required.
• Three plus year’s pharmacy or pharmacy benefit management experience.

PHYSICAL REQUIREMENTS:

• Predominately sedentary office position with high frequency of keyboarding/computer work required (80% to 100%) of the workday
• Close vision required

Please email your resume to: cdominguez@ramsellcorp.com